The presence of post-traumatic stress disorder (PTSD) in women with fibromyalgia (FM) further weakens their cardiovascular response to stress, which seems to depend largely on the presence of depression symptoms, a study reports.
According to researchers, the results underline the importance of detecting and treating PTSD and concomitant depression for the successful management of FM.
The study, “Cardiovascular Responses of Women with Fibromyalgia to a Laboratory Stressor: Does Post-traumatic Stress Disorder Comorbidity Matter?” was published in the journal Pain Medicine.
Post-traumatic stress disorder (PTSD) is a mental health disorder common among FM patients, reported in more than half the patients in some studies.
This disorder shares some physiological characteristics with FM, including a lower cardiovascular response — heart rate and blood pressure — upon experiencing stress.
In addition, PTSD and depression, often associated with FM, have been shown to mediate the relationship between early trauma and pain severity. Stress is also known to worsen the feelings of pain in the everyday lives of women with FM.
Therefore, “it seems of particular importance to shed light on the possible contributions of PTSD and depression to the efficiency of the stress response in patients with FM,” the authors of the study wrote.
Led by researchers with the King Juan Carlos University in Spain, the team compared the cardiovascular response to stress (reactivity and recovery) in a group of 18 women with FM and comorbid PTSD, a group of 18 women with FM without PTSD and a control group of 38 healthy women. Mean age in each group was 51, 57 and 49, respectively.
Researchers decided to focus the study only on women, who have a higher prevalence of FM than men.
Each group of participants was exposed to a trauma-unrelated stress task — they were asked to count numbers backward as quickly as possible while repeatedly being harassed and interrupted by one of the researchers.
Their blood pressure and heart rate were measured while they performed such a task and afterward, while they recovered.
In both groups of FM patients (with and without PTSD), the heartbeat accelerated less in response to the stressful task, compared with the healthy controls, suggesting that FM leads to a blunted reactivity to stress.
In terms of blood pressure, specifically the highest (systolic blood pressure), only those with comorbid PTSD presented a weaker reaction.
Importantly, the data suggested that the presence and severity of depression symptoms likely contributed to the lower response, both in the two groups of FM patients and healthy controls (although overall the latter had fewer depression symptoms than FM patients).
In addition, the heart rate and blood pressure in both groups with FM decreased significantly more slowly after the task compared with healthy participants, revealing a slower rate of recovery associated with FM. Their final recovery state, however, was as good as the controls.
Researchers say these results have significant health implications. The presence of a blunted cardiovascular response in FM patients may make them more vulnerable to stress and pain, and comorbid PTSD and depression could aggravate this effect.
Therefore, the study potentially supports “the well-recognized strategies of detection and treatment of PTSD and concomitant depression in the management of FM,” researchers said.
More effort should be put into restoring the patients’ physiological response to stress, using a more motivational and targeted approach to help them cope, the team said. For that, management of depression “should be potentially considered a priority in the clinical setting.”
Future studies should look at the influence of PTSD on the cardiovascular reaction of FM patients in real-life settings, researchers concluded.